Back 4 Blood Wiki

A large totem capable of deadly overhead swings.
"It is our great honor to accept this glorious gift..."
"...and willingly bear the Mark of the Chosen for..."
"...Blessed are the Children of the Worm."

In-game description

The Skull Totem is a melee weapon featured in Back 4 Blood.
This weapon can only be acquired and wielded within Ridden Hives and Inner Lairs.
Players can find them at various locations and combine them from rare up to legendary quality.

This weapon does not only serve as a weapon but also as a currency Skull Totems that can be used on the Skull Totem Track called The Collectors to buy new cards and a myriad of cosmetic items that have been introduced with the Tunnels of Terror expansion. In order to convert this weapon into the Skull Totems currency, at least one player has to wield a Skull Totem in their hands while exiting a Ridden Hive or Inner Lair.